Pregnancy blues

I think you may have saved my life", was the frank response from one Sunshine Coast mother to psychologist Lisa Lindley after attending her first counselling session for a severe case of antenatal depression.

"I don't know where I'd be without someone to talk to about how I was honestly feeling about my pregnancy. I consider myself to be a very competent person, and all of a sudden I was on this downward spiral of depression and negative thoughts. It was overwhelming and I couldn't see an end to these awful feelings. It is such a private illness and I didn't want anyone to know I wasn't coping."

It's this sort of feedback and the experience of working with women suffering from antenatal and postnatal depression which led Lindley to set up a voluntary support group on Queensland's north coast three years ago. The support group meets each week during school terms. Lindley believes these group sessions are the single most important aspect of the therapy she offers her patients. "You hear it over and over again, and it's true. Listening to other people talk about their problems and being able to share your own experiences in a safe environment helps people feel connected and supported at a time when they can be feeling very isolated by their illness," she says.

Interestingly, while postnatal depression is more widely recognised as an illness than antenatal depression - affecting one in seven women compared to one in 10 for antenatal depression - the symptoms are the same. "50 per cent of women who suffer antenatal depression go on to develop postnatal depression so there are compelling reasons to seek help if your mental health during pregnancy is a concern," Lindley says. "Counsellors can work with sufferers to put in place lifelong practical strategies to minimise stress and improve mental health and resilience." Lindley said the good news is the majority of her patients get through this period of their life and go on to lead full and happy lives with their families, albeit more aware of the need to keep on top of their mental health.

Symptoms of antenatal depression include feeling overwhelmed by everyday living, constantly teary, irritable, angry or anxious and unable to concentrate. Feeling guilty, a loss in confidence, sleeping problems and changes in appetite are also common. In more severe cases, thoughts of self harm can create enormous stress for sufferers and their families and friends. Environmental factors can make women more susceptible to antenatal depression. These might include a personal or family history of depression, major life changes such as divorce, moving, financial or health problems, medical concerns about the pregnancy, previous pregnancy loss, a lack of social support or a history of abuse.

Common medical causes of depression include low thyroid function, brain injuries, a stroke, heart disease, head injury, epilepsy, some forms of cancer and Parkinson's Disease. Anaemia, infectious disease, diabetes, hypertension, some steroid and hormonal treatments, chronic pain and giving up smoking can also contribute to a depressive illness. As a clinical nurse consultant with the Royal Brisbane & Women's Hospital's perinatal mental health service, Jane Whitford knows the value of early intervention for women suffering antenatal depression. The service provides weekly public clinics for perinatal women, which is classified as the period from conception to two years after the birth of a baby.

"We work with patients to help them overcome any negative feelings towards their baby and better understand what's happening to them and why," Whitford says. "Interestingly, we have noticed an increase in referrals for antenatal patients to our service from general practitioners and obstetricians in our catchment area which indicates better awareness about how serious antenatal depression can be." Whitford says a prior history of depression needs to be closely managed during pregnancy. "Some women assume they must automatically stop taking antidepressant medication when they fall pregnant, which can have serious mental health implications if not managed correctly," Whitford says.

"We prefer to do a risk-benefit analysis with patients to work out what is best for them and for the baby. There are some antidepressant medications which should be used with caution during pregnancy but not all medication is the same and in some cases lower dosages can be recommended or medication changed to a safer option. This is all done in consultation with the patient's own doctor or specialist as depression is a serious illness." Whitford said physical conditions can also affect a woman's mental health during pregnancy. Severe ligament and pelvic pain and extreme nausea and vomiting can all take their toll. Concerns about the baby's wellbeing or a women's previous experience with a fetal death or still birth can also have an impact on mental health.

"It's hard to feel positive about a pregnancy when physically you are feeling awful or are in pain, so we work with our patients to try and relieve these problems by recommending physiotherapy, massage, appropriate pain relief, nausea medication and helping them make better lifestyle choices," she says. Belmont Private Hospital on Brisbane's southside is another facility which offers a specialised service to treat women suffering from mood disorders and mental health issues during pregnancy or postnatally. The Brisbane Centre for Postnatal Disorders is based at the hospital and offers a holistic approach to treating perinatal depression, taking into account biological, psychological and family history factors. Counsellors involve partners, babies, other children within the family and sometimes friends in the treatment and recovery process. Unit manager Mary Williams says patients can attend a range of inpatient and outpatient programs, couples communication and parenting skills workshops, partner information evenings and relapse prevention and follow-up programs. Williams says the period of time to treat antenatal depression varies between individuals as some will go on to develop postnatal depression and others fully recover after treatment.

An organisation at the forefront of mental health awareness and research in Australia, beyondblue: the national depression initiative has long recognised the importance of detecting and treating mental health disorders in the perinatal period. Deputy chief executive officer of beyondblue Dr Nicole Highet says pregnancy and early parenthood can be a time in a woman's life when the risk of developing a mental health problem increases. "For some women, being pregnant or having a baby can trigger symptoms ranging in severity from emotional distress to depression, anxiety and related disorders," Dr Highet said. "There is clear evidence that if left untreated, there can be serious consequences for mothers, their babies and families." Since 2008 beyondblue has worked with mental health experts, people who have experienced depression and carers to develop Australia's first draft clinical practice guidelines for the treatment of perinatal mental health problems.

The guidelines are part of an $85 million National Perinatal Depression Initiative funded by state, territory and federal governments. Once public submissions have been considered, the guidelines will be submitted to the National Health and Medical Research Council for approval. According to the Manager of Women's Health Queensland Wide, Kathy Faulkner, this type of national response is well overdue. "What is also well overdue are women themselves recognising that they don't have to be perfect and that there will be days when things don't go according to plan," she says. "Whether you're pregnant and feeling incredibly anxious or have a new baby at home and are struggling to keep it together, give yourself a break. Meet a friend for a coffee, go for a walk or make an appointment to see a professional counsellor to talk about how you're feeling. There is help there if you need it."

Help for women suffering antenatal depression is available from a range of health professionals including general practitioners, psychologists, psychiatrists, mental health nurses and social workers and occupational therapists who specialise in the mental health area.

This article was originally published in Womens Health Qld